Suture clip

ABSTRACT

In order to promote even healing and minimize scarring, this application discloses a flat clip to be applied to each end of a thread drawn by a needle through the edges of the wound until the clip lies flat against the surface of the skin. The application also discloses a tool carrying a cartridge holding a supply of clips for securing the clips on the thread and severing it. In addition, there is shown a tool for removing the clips from the thread so that the sutures may be removed when the wound has healed.

United States Patent Wood et a1. Aug. 21, 1973 1 SUTURE CLIP 3,006,34410/1961 Vogelfanger 128/334 x 3,175,556 3/1965 Wood et a1. 128/346 xInventors: Ernest 12 I h -i 3,541,591 11/1970 I-Ioegerman 128/335 LosAngeles, 90039; Peter B, samuels, 53 3 Balboa Blvd" Encino, FOREIGNPATENTS OR APPLICATIONS both of Calif. 913 16 494,960 6/1919 France128/335 Primary Examiner-Donald L. Truluck Attorney-McDougaIl, Hersh &Scott 5 7 ABSTRACT In order to promote even healing and minimizescarring, this application discloses a flat clip to be applied to eachend of a thread drawn by a needle through the edges of the wound untilthe clip lies flat against the surface of the skin. The application alsodiscloses a tool carrying a cartridge holding a supply of clips forsecuring the clips on the thread and severing it. In addition, there isshown a tool for removing the clips from the thread so that thesutures'may be removed when the wound has healed.

2 Claims, 8 Drawing Figures SUTURE CLIP This application is acontinuation of our co-pending application, Ser. No. 817,496 filed Apr.18, 1969, now abandoned.

This invention relates to surgical devices. More specifically, itrelates to devices useful for the suturing of skin wounds.

The conventional method of closing skin wounds consists of sewing theedges of the wound together with thread. Threads are placed and tiedseparately along the wound and are termed interrupted sutures."Alternatively, wounds may be closed by a continuous thread anchored bytying the thread at either end of the wound. Very frequently woundssutured in accordance with these techniques tend to have the edgesinverted so that when healed a noticeable scar may remain. Also, it isnot uncommon that the healing may be uneven to such an extent as todelay complete healing and to further aggravate the scarring situation.

It is an object of this invention to provide a novel apparatus forsuturing skin wounds which promote even healing.

It is still a further object of this invention to provide a novelapparatus for suturing skin wounds which eliminates any encirclingthread over the wound, thus eliminating the possibility of across-hatched scar.

These and other objects are achieved by novel clips secured to the freeend of a thread which is then drawn through the edges of the wound untilthe clip contacts the surface of the skin at one edge, permitting theedges of the wound to be drawn together, at which time another clip maybe applied to the thread to secure the thread in the wound.

In an important aspect of the invention there is provided a novel clipformed as a flat member out of a material with sufficient resiliency andstrength so that it can be clamped about a suturing thread.

BRIEF DESCRIPTION OF THE DRAWINGS These and other objects and advantagesof this invention will hereinafter appear and for purposes ofillustration, but not of limitation, an embodimentof the invention isshown in the accompanying drawings in which:

FIG. 1 is a plan view of an applicator tool embodying the invention andsuitable for carrying out the inventive method;

FIG. 2 is a plan view of a cartridge holding a supply of clips inaccordance with the invention;

FIG. 3 is an end view of the cartridge of FIG. 2;

FIG. 4a is a plan view of a clip in accordance with the invention shownprior to its assembly on a thread;

FIG. 4b is a view of a clip in accordance with the invention showing theposition assumed upon its assembly on a thread;

FIG. 5a is a diagrammatic illustration showing the use of a thread onwhich a clip has been secured in suturing a wound;

FIG. 5b is a diagrammatic figure similar to FIG. 5a in which severalsutures have been completed using the method and apparatus of theinvention;

FIG. 6 is an illustration of a tool suitable for removing clips from athread in accordance with the invention.

DETAILED DESCRIPTION This invention is practiced by applying a flat clipto the end of a thread and passing the thread through the skin, using asurgical needle, until the clip lies flat against the surface of theskin at one edge of the wound. This is illustrated in FIG. 5a where aclip 2 has been clamped to a thread 4 and the thread, in turn, threadedthrough a suitable surgical needle 6. The thread 4 has been drawnthrough the surface of the skin at one edge 8 of a wound and the clip 2lies flat against that surface of the skin. The needle 6 is then used topenetrate the surface of the other edge 10 of the wound from theunderside and emerge from the upper side of that edge. At that pointanother clip 2 is applied to the thread 4 and the thread is thensevered. In order to facilitate the suturing, an applicator tool isconstructed to apply two clips simultaneously to the thread and to severthe thread between the two clips. In this manner, the emerging end ofthe thread is clipped and the suture secured, and at the same time thethread is provided with a clip at its free end to commence the nextsuturing operation. This sequence of operations is repeated to theextent necessary to close the wound, as may be seen in FIG. 5b whereinseveral sutures of the interrupted variety have been applied, eachsuture consisting of a pair of clips 2 and a thread 4. During eachsuturing operation the thread is pulled sufficiently tight to bring theedges of the wound together and to evert them slightly. If desired, acontinuous suture could be applied with a clip at each end.

It has been found that in addition to fixing the thread in place theclips spread the pull exerted at the skin edge by the thread over theentire surface of the clip and thus spread the pressure at the point ofengagement of the clip with the skin over the entire clip, thusrelieving the pressure from a restricted area. It has also been foundthat the clips tend to assume a position parallel to each other, thuscontributing to the eversion of the skin edge. By resisting the naturaltendency of the skin edge to turn inward, even healing is promoted andscarring is minimized. .Another advantage of this method results fromthe tendency of the clips to immobilize the skin beneath them, that is,they, in effect, splint the skin edge and prevent its movement. Thissplinting effect" also helps to minimize scarring of the wound byallowing healing to proceed with the wound immobilized.

Since the practice of this method eliminates threads overlying thewound, there is no cross-hatched scar as is seen in wounds sutured bythe prior art methods. In addition, the absence of a circular suturerelieves the wound of any circumferential compression.

In order to practice the invention, the clip applicator tool illustratedin FIGS. 1 through 3 may be used. As seen in FIG. 1, the clip applicatorcomprises a body portion 14 on which the remaining elements of theapplicator are mounted for use. These elements comprise a pair of handleportions 16 and 18 pivoted at points 20 and 22, respectively, on theforward end of the body portion. Passing through the body portion is achannel guide 24 which is provided at its rearward end with a springclip 26 which is normally urged upward from the bottom of the channelguide 24 to hold a cartridge 28 in the channel guide. The cartridge 28extends through the body portion and has a front end 30 which terminatesin a pair of V-shaped openings 32 adjacent the confronting ends 34 and36 of a pair of jaws 38 and 40, respectively, which are pivoted on thebody portion at the points 42 and 44, respectively. A pair of outwardlybowed leaf springs 43 and 45 urge the jaws 38 and 40 outwardly from thebody portion 14. The handle 16 has secured to its undersurface a leafspring 46 which slides at its inner end on the surface of the channelguide 24 to normally urge the handle 16 in an outward direction. Asimilar leaf spring 48 is secured to the handle 18 for the same purpose.The handles 16 and 18 are provided with enlarged portions 47 and 49,respectively, which bear on the jaws 38 and 40 and function as cammingsurfaces to cause inward movement of the jaws when the handles areforced inwardly. A pair of stops 50 and 52 may be provided on the bodyportion, engaging with the handles 16 and 18, respectively, to limittheir outward movement.

The cartridge 28 is illustrated in greater detail in FIGS. 2 and 3. Asillustrated, it takes the form of an elongated rectangular memberprovided witha pair of slots 54 and 56 extending along its length intowhich clips to be applied to a thread may be stored and from which theymay be fed for compression by the jaws 38 and 40 as required. A means toforce the clips forward in the slots 54 and 56 is constituted by a slide58 having a handle portion 60 extending through an elongated opening 62extending over a major portion of the length of the cartridge 28. Anotch 64 is formed in the end of the cartridge 28 to permit passage of athreadsevering means in a manner to be described in greater detailhereinafter. Instead of using a handle to urge the slide forward, aspring feed could be provided.

The thread-severing means is constituted by an arm 66 pivoted coaxiallywith the jaw 40 at 44 but capable of independent movement and carryingat its free end a cutting edge 67 and a projection 68 which acts tomaintain a thread in position to be cut. Extending from the arm 66through an opening in the jaw 40 is a projection 70 engageable with thepivoted handle 16.

The operation of the applicator tool 14 in conjunction with thecartridge 28 is as follows. After the cartridge 28 is caused to befilled with an appropriate number of clips in the slots 56 and 54, thecartridge is inserted into the channel guide 24 until its forward motionis stopped by virtue of its contact with the confronting surfaces 34 and36 of the jaws 38 and 40. It is retained in this position by theengagement of the spring clip 26 with its rear end. In order to feedclips to a position to be applied to a thread, the slide 58 is movedforward by applying pressure to the handle 60 so as to feed clipsforward to a position between the jaws. As may be seen in FIG. 1, theforward movement of the slide 58 is permitted by the provision of aslotted opening 66 in the body portion 14. The forward motion of theclips is limited by their engagement in cut-out portions 71 formed inthe confronting surfaces 34 and 36 of the jaws 38 and 40.

Referring to FIGS. 3a and 31), it may be seen that each clip 2 is formedas a thin, flat member having notch 72 formed at its lower end and apair of spreadapart legs 74 and 76 forming a wider notch 78 at its upperend. When inserted into the slots 54 and 56, the clips nest within eachother, i.e., the narrow part of a clip with the notch 72 rests withinthe wider notch 78 of each adjacent clip. As may best be seen in FIGS. 2and 4a, the outer surfaces 82 and 84 extending from the end of the widenotch are substantially parallel to each other to engage and be alignedby the straight sides of the slots 54 and 56 when the clips are placedin the cartridge 28. Thus, when the clips are moved forward in thecartridge 28 by the action of the slide 58, they are positioned in thecut-out portions 71 with the notch 78 exposed between the confrontingportions 34 and 36 of the jaws 38 and 40. With the clips so positioned,a thread is laid between the confronting portions in the notches 78 ofthe clips. The handles 16 and 18 are then squeezed together about theirpivots 20 and 22. By virtue of their engagement with the forward ends ofthe jaws 38 and 40 these jaws are caused to rotate inwardly about theirpivots 42 and 44 moving the confronting ends 34 and 36 together.

The pressure caused by the inward motion of the confronting ends 34 and36 causes the legs 74 and 76 of the clips to be moved toward each othersecuring or clamping the clip about the thread in what was the notch 78.The dimensions are such that the legs 74 and 76 move into substantialcontact with each other and are securely fastened to the thread leavinga small notch 80 in the upper end of the clip, as may be seen in FIG.4b. Further compression of the handles 16 and 18 causes the inner sideof the handle 16 to bear against the projection on the arm 66 so that itcontinues to move inwardly, whereby the severing edge 68 on the end ofthat arm cuts the thread in between the two clips. When the thread hasbeen severed there results an arrangement where two clips have beenapplied, one to each end of the severed thread. In practice, it has beenfound desirable to dimension the-clips and the applicator tool 14 so asto apply them to the thread approximately one centimeter apart.

The clipped ends of the thread are now ready for use in the practice ofthe method described above. The clipped thread which has been severedfrom a longer piece may be discarded and the first suturing operationbegun using the clipped thread remaining. In the execution of thesuturing operation after the thread has been drawn through both edges ofthe wound and the wound drawn together, the applicator tool may again beused by first feeding forward another pair of clips to a positionbetween the confronting ends 34 and 36, then using the applicator toolin the manner described above. This results in a clip being applied tothe emerging end of the thread, such aclip being designated by referencenumeral 12 in FIG. 5b, and a clip has been secured to the free end ofthe thread so that another suturing operation may be commenced.

After the wound has healed and it is desired to remove the sutures, theinvention provides a removing tool or opener illustrated in FIG. 6. Thisis constituted by a pair of pivoted handles 86 and 88 which are providedat their free ends with a pair of pointed projections 90 and 92,respectively. These projections may be engaged in the notches 72 and ofa clip and the handles brought together to force the projections intothose notches and spread apart or open the clip to remove it from thethread. When the clips on each side of the wound are removed, thesuturing thread may be withdrawn in the usual manner.

It is to be understood that changes may be made in the details ofconstruction, arrangement, and operation without departing from thespirit of the invention, especially as defined in the following claims.

What we claim and desire to secure by Letters Patent of the UnitedStates is:

l. A clip for holding thread in position on sutured wounds comprising: athin flat member having a first end; a second end constituted by a pairof spaced apart legs forming a relatively wide notch; the outer sides ofeach of said spaced apart legs having a first surface extending from theouter ends of said legs spaced from said first end to a pointintermediate the length of said legs, said first surfaces of each legbeing substantially parallel to each other whereby said clips may bealigned in an elongated clip holder having straight parallel sides andhaving a second surface continuing from the termination of said firstsurface, said second surfaces converging toward each other to form saidfirst end, whereby said first end is relatively narrow with respect tosaid second end so that the first end of one clip can be positionedwithin a clip holder, the relatively wide notch of a second clip forstorage purposes; and a relatively narrow notch formed in said first endto facilitate the bending toward each other of said spaced apart legs.

2. A clip as set forth in claim 1 in which said spaced apart legs areshaped at their outer ends to form a relatively narrow notch when theyare bent toward each other to provide a narrow notch at each end of theclip for engagement by elements of a clip removing tool.

I i i i

1. A clip for holding thread in position on sutured wounds comprising: athin flat member having a first end; a second end constituted by a pairof spaced apart legs forming a relatively wide notch; the outer sides ofeach of said spaced apart legs having a first surface extending from theouter ends of said legs spaced from said first end to a pointintermediate the length of said legs, said first surfaces of each legbeing substantially parallel to each other whereby said clips may bealigned in an elongated clip holder having straight parallel sides andhaving a second surface continuing from the termination of said firstsurface, said second surfaces converging toward each other to form saidfirst end, whereby said first end is relatively narrow with respect tosaid second end so that the first end of one clip can be positionedwithin a clip holder, the relatively wide notch of a second clip forstorage purposes; and a relatively narrow notch formed in said first endto facilitate the bending toward each other of said spaced apart legs.2. A clip as set forth in claim 1 in which said spaced apart legs areshaped at their outer ends to form a relatively narrow notch when theyare bent toward each other to provide a narrow notch at each end of theclip for engagement by elements of a clip removing tool.